Cost Program: Barbados Experience

Jonathan M. YearwoodJonathan M. YearwoodResearch and Information OfficerResearch and Information Officer

National Council on Substance AbuseNational Council on Substance Abuse(NCSA)(NCSA)

Barbados’ Contribution to the Cost Study

Estimating The Human, Social, and Economic Costs of Drugs in the

Americas

Barbados’ Contribution to the Cost Study

The NCSA (Barbados) conducted three (3) separate studies. These reports were:

Estimating Direct Government Expenditure on Drug Demand Reduction in Barbados (November 2003)

Survey of Emergency Rooms in Barbados (September 2004)

The Estimation of Costs Attributable to Substance Abuse and Loss of Productivity for Inmates at Glendairy Prison: Barbados (November 2004).

Estimating Direct Government Expenditure

on Drug Demand Reduction in Barbados

(EDGE)

Objectives of the EDGE Study

The main objectives of the study were:To estimate Government Expenditure on

demand reduction activities; To collect and report data required for the

indicators known as level one indicators; To provide a basis on which to build future

studies as the pilot project progresses.

Methodology

The methodology employed was:The use of secondary data on drug related

costs and activities for some institutions in the health and criminal justice sectors.

The secondary data provided the basis for estimating government expenditure.

Table 1 Estimates of Total Government

Expenditure on Demand Reduction  

Year

Institution 1996 1997 1998 1999 2000

           

NCSA $624,457 $678,323 $706,077 $989,036$1,256,04

9

           

Drug Rehab Unit $4,578,50

9$4,954,810

$4,436,461

$2,221,621

$2,093,553

           

Total $5,202,966

$5,633,133

$5,142,538

$3,210,657

$3,349,602

Figure 1Estimate of Total Government

Expenditure on Demand Reduction

1996 1997 1998 1999 2000

$0.00

$1,000,000.00

$2,000,000.00

$3,000,000.00

$4,000,000.00

$5,000,000.00

$6,000,000.00

Estimate of Total Government Expenditure on Demand Reduction

Analysis of EDGE Study

Administrators need to keep track of spending.

No data is provided for yearly requests and therefore an estimate cannot be provided.

Analysis of EDGE Study

A standardised data collection instrument for all health-care providers.

Central depository for studies of this type will be needed.

Survey of

Emergency Rooms in Barbados

(The ER Study)

Objectives of ER Study

To determine the prevalence of drug use in the patients

To establish the relative importance and the characteristics of drug use

To quantify the association between drug use and accidents.

To test a methodology that may be easily applied in different countries.

Collect data on Level 1 direct cost indicators..

Methodology

The study was conducted at the two institutions (QEH and FMH).

A CICAD standardized questionnaire was used.

Interviews were conducted on a 24-hour & 18 hour respectively.

The study was conducted among persons - 12 years and older.

Data was collected a two-week period.

Survey Information

Patient Data collected:– the date and time of the emergency;– basic demographics of the patients;– type of emergency;– substance use in the six hours prior to the interview;

and– the possible relationship between consumption and the

emergency. Doctor’s clinical impression was notedNo laboratory tests were conducted

Estimation of ER Cost Data - QEH

The 1996 by Boston University Report guided the survey.

The cost data for the survey was based on assumed patterns of expenditure for 1995 – 2003.

Pattern of Expenditure for QEH

In 1995: Expenditure on the QEH = $83.9m.

– $5.2m (6.2%) – A & E services.

In 2002 – 2003Expenditure on the QEH = $115.3m.

– $7.15m (6.2%) A & E services

Pattern of Expenditure for QEH Cont’d

The ER study shows – 3.6% had an emergency related to drug

use;– 3.6% of the expenditure was consistent for

two years;Estimated cost for 2002 – 2003 =3.6%

of 7.15m ($260,000) could have been spent on drug related accidents at the QEH.

Analysis of ER Study

Survey was conducted over a normal two (2) week period.

Estimate of 0.8% of admissions are drug related.

A rough estimate of admittances from drug consumption should be given.

The Estimation of Costs Attributable to Substance Abuse

and Loss of Productivity for Inmates at

Glendairy Prison in Barbados (The Prison Study)

Objectives of the Prison Study

Objectives of the prison study were to determine: – The relationship between drug use and criminal

behaviour;– The frequency of drug use;– Persons imprisoned for crimes or offences

associated with substance use;– Type of offences committed;– The economic loss due to drug related crime

Methodology

A random stratified sample among non-remand inmates;

150 inmates were chosen;

The actual sample size was 140 inmates (93%)

Stratified Sample

Type of

crimes

Other RTO Damage Robbery Theft Burglary Fire-arms

Sexualcrimes

Drugcrime

Violentcrimes

Total

Non-remand

52 12 12 59 133 68 68 57 200 166 817

Percent 6% 1% 1% 7% 16% 8% 8% 7% 24% 20% 100

Sample 9 2 2 11 24 12 12 10 37 30 150

Major Categories of the Survey

Under the influence of illicit drugs and alcohol.

Acquisition of drugs.

Involvement in the drug economy.

Drug trafficking and production:

Economic Loss Due to Drug-related Crimes

The formula

Cost of incarceration

Loss of productivity cost

Economic cost of a prisoner

(Perez et al 2004)

+

Cost of Incarceration Results

The average cost – Daily = BDS $33.65.– Over eight years (1996 -2004) = $72,962.83.

To maintain the 19 inmates for the duration of their sentences

BDS $1,386,293.69.

Loss of Productivity Results

The average loss of productivity – BDS $14,378.42

The total loss of productivity – BDS $273,190.00

Almost four times less than the cost of housing the prisoners.

Total Economic Loss

19 (10%) inmates over the eight year period – BDS$87,341.25

The total economic loss to Barbados – $1,659,483.69,

Estimated cost to the Barbadian government – $16,600,000.00

INMATEID

MOUTHSIN PRISON

NO. OFCONVICTIONS

LENGTH OFSENTENCE

(MTHS)

TOTAL COSTPER DAY

DAILYCOST

WAGESPER MTH

COST INPRISON

ECONOMICLOSS

1 9 1 18 $8,662.23 $33.97 $6,192.86 $17,120.64 $23,313.50

2 39 1 60 $36,150.75 $33.26 $26,398.57 $55,872.36 $82,270.93

3 9 1 18 $8,356.50 $33.97 $5,974.29 $17,120.64 $23,094.92

4 49 1 180 $45,241.36 $32.97 $33,320.00 $166,192.75 $199,512.75

5 13 1 36 $12,578.01 $33.81 $9,034.29 $34,082.36 $43,116.64

6 16 1 36 $15,253.31 $33.75 $10,977.14 $34,016.22 $44,993.36

7 28 1 60 $25,807.10 $33.52 $18,700.00 $56,306.39 $75,006.39

8 7 1 30 $6,488.18 $33.97 $4,638.57 $28,534.40 $33,172.97

9 7 1 24 $7,031.69 $33.97 $5,027.14 $22,827.52 $27,854.66

10 49 1 180 $45,241.36 $32.97 $33,320.00 $166,192.75 $199,512.75

11 5 1 60 $4,517.95 $33.97 $3,230.00 $57,068.80 $60,298.80

12 8 1 132 $7,439.33 $33.97 $5,318.57 $125,551.35 $130,869.92

13 8 1 60 $7,677.11 $33.97 $5,488.57 $57,068.80 $62,557.37

14 48 1 60 $44,547.55 $33.02 $32,761.43 $55,478.05 $88,239.48

15 49 1 300 $45,241.36 $32.97 $33,320.00 $276,987.92 $310,307.92

16 16 1 48 $14,651.36 $33.76 $10,540.00 $45,371.97 $55,911.97

17 7 1 60 $6,997.72 $33.97 $5,002.86 $57,068.80 $62,071.65

18 26 1 60 $24,524.69 $33.55 $17,752.86 $56,363.18 $74,116.03

19 9 1 60 $8,662.23 $33.97 $6,192.86 $57,068.80 $63,261.65

TOTAL       $375,069.78 $639.31 $273,190.00 $1,386,293.69 $1,659,483.69

MEAN       $19,740.51 $33.65 $14,378.42 $72,962.83 $87,341.25

Analysis Prison Study

The formula is unclear as outlined below:

– Number of Convictions vs. Total sentences:

– Length of Sentence:

Analysis Prison Study Cont’d

A systematic database of prison records which includes

– reason for incarceration, – length of sentence, – profession and – average income.

Analysis Prison Study Cont’d

Estimating loss of productivity:

Due to the non-normal distribution of income in Barbados, the loss of productivity would be underestimated.

If median income in the island is utilised, a more accurate figure may result.

Conclusion

The Cost Studies provided baseline data from which government expenditures on demand reduction activities and prison costs could be estimated.

These costs estimations may vary from existing government procedures for estimating costs.

Conclusion

The gap between government estimates and those of the cost studies may vary due to the presence of other tangible and intangible costs absent from the cost study estimates.

What is therefore needed is a bridging of

government and cost study estimates which

will allow for more robust costs estimations.

Discussion